While TDR remained stable throughout the study period, clinically relevant resistance to first line drugs showed a significant trend to a decline (p = 0.02). Differences were due to a lower prevalence in clinically relevant resistance for NRTIs and PIs, while it was higher for NNRTIs. A total of 188 patients showed clinically relevant resistance to first-line ARVs, and 221 harbored TDR using the WHO list. 70% of the TDR found using the WHO list were relevant for first-line treatment according to the Stanford algorithm. Using the Stanford algorithm "Low-level resistance", "Intermediate resistance" and "High-level resistance" categories were considered as "Resistant". We analysed 2781 sequences from ARV naive patients of the CoRIS cohort (Spain) between 2007-2011. The aim was to analyse trends in clinically relevant resistance to first-line antiretroviral drugs in Spain, applying the Stanford algorithm, and to compare these results with reported Transmitted Drug Resistance (TDR) defined by the 2009 update of the WHO SDRM list. Monge, Susana Guillot, Vicente Alvarez, Marta Chueca, Natalia Stella, Natalia Peña, Alejandro Delgado, Rafael Córdoba, Juan Aguilera, Antonio Vidal, Carmen GarcÃa, Federico All rights reserved.Ĭlinically relevant transmitted drug resistance to first line antiretroviral drugs and implications for recommendations. It is crucial to increase the awareness of national and European policymakers, oncological societies, melanoma patients' associations and pharma industry.
Great discrepancy exists in metastatic melanoma treatment across Europe. Significant correlation was found between human development index (HDI, UNDP report 2015), (r = 0.662 p < 0.001), health expenditure per capita (r = 0.695 p < 0.001) and the Mackenbach score of health policy performance (r = 0.765 p < 0.001) with the percentage of patients treated with innovative medicines and a number of reimbursed medicines. It was estimated that in Europe 19,600 patients with metastatic melanoma are treated, and 5238 (27%) do not have access to recommended first-line therapy. First-line immunotherapy with anti-PD1 antibodies was registered and fully reimbursed in 14/30 (47%) countries, while in 13/30 (43%) (all from Eastern Europe) not reimbursed.
The recommended BRAF inhibitor (BRAFi) + MEK inhibitor (MEKi) combination was both registered and fully reimbursed in 9/30 (30%) countries, and in 13/30 (43%) (all from Eastern Europe) not reimbursed. Web-based online survey was conducted in 30 European countries with questions about the treatment schedules from 1st May 2015 to 1st May 2016: number of metastatic melanoma patients, registration and reimbursement of innovative medicines (updated data, as of 1st October 2016), percentage of patients treated and availability of clinical studies and compassionate-use programmes. We analysed the availability of these innovative therapies in Europe and estimated the number of patients without access to first-line recommended treatment per current guidelines of professional entities such as the European Society for Medical Oncology (ESMO), the European Organisation for Research and Treatment of Cancer (EORTC), the European Association of Dermato-Oncology (EADO), and European Dermatology Forum (EDF). Kandolf Sekulovic, L Peris, K Hauschild, A Stratigos, A Grob, J-J Nathan, P Dummer, R Forsea, A-M Hoeller, C Gogas, H Demidov, L Lebbe, C Blank, C Olah, J Bastholt, L Herceg, D Neyns, B Vieira, R Hansson, J Rutkowski, P Krajsova, I Bylaite-Bucinskiene, M Zalaudek, I Maric-Brozic, J Babovic, N Banjin, M Putnik, K Weinlich, G Todorovic, V Kirov, K Ocvirk, J Zhukavets, A Kukushkina, M De La Cruz Merino, L Ymeri, A Risteski, M Garbe, Cĭespite the efficacy of innovative treatments for metastatic melanoma, their high costs has led to disparities in cancer care among different European countries. More than 5000 patients with metastatic melanoma in Europe per year do not have access to recommended first-line innovative treatments.
0 kommentar(er)
